Form I-918 - Petition For U Nonimmigrant Status
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8OMB No. 1615-0104; Expires 07/31/2012
I-918, Petition for
Department of Homeland Security
U Nonimmigrant Status
U.S. Citizenship and Immigration Services
START HERE - Please type or print in black ink.
For USCIS Use Only.
Returned
Receipt
Part 1.
Information about you.
(Person filing this petition as a victim)
Date
Family Name
Given Name
Middle Name
Date
Resubmitted
Other Names Use (Include maiden name/nickname)
Date
Date
Home Address - Street Number and Name
Apt. #
Reloc Sent
Date
City
State/Province
Zip/Postal Code
Date
Reloc Rec'd
Apt. #
Safe Mailing Address (if other than above) - Street Number and Name
Date
Date
C/O (in care of):
U.S. Embassy/Consulate:
Validity Dates
City
State/Province
Zip/Postal Code
From:
To:
Home Telephone #
Safe Daytime Phone #
E-Mail Address
Remarks
(with area code)
(with area code)
(optional)
A # (if any)
U.S. Social Security # (if any)
Gender
Male
Female
Conditional Approval
Marital Status
Stamp #:
Date
Single
Married
Divorced
Widowed
Action Block
Date of Birth (mm/dd/yyyy)
Country of Birth
Country of Citizenship
Passport #
Place of Issuance
Date of Issue (mm/dd/yyyy)
To Be Completed by
Attorney or Representative, if any.
Place of Last Entry
Date of Last Entry (mm/dd/yyyy)
Fill in box if G-28 is attached to
represent the applicant.
I-94 # (Arrival/Departure Document)
Current Immigration Status
ATTY State License #
Form I-918 (Rev. 11/23/10 Y)
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